This study was conducted to evaluate the impacts of perceived environmental pollution on health and analyzed the impacts of rural and urban residents’ perceived environmental pollution on health.
Perceived environmental pollution
This study highlighted the impacts of perceived environmental pollution on health, especially among urban residents. The study found that the rates of urban residents who perceived air pollution (35.67%), water pollution (17.96%), garbage pollution (25.05%), and noise pollution (32.05%) were higher than those of their rural counterparts, which means that urban residents perceive more environmental pollution than their rural counterparts. This outcome was similar to the results of a local study on environmental awareness that used data from the Chinese General Social Survey (CGSS) in 2010 . A Western study also found that urban residents are assumed to be more environmentally concerned than their rural counterparts . Perceived air pollution, garbage pollution and noise pollution all had a significant negative impact on urban residents’ health, while none of the perceived pollution types had a significant impact on rural residents’ health. However, China’s environmental pollution is severe in both cities and villages. In recent years, the air pollution level has decreased quickly, although the levels are still high . Despite measures such as limiting cars on the roads, reducing exhaust emissions and the technical development of air purification, China’s large-scale air pollution continues to spread from north to south. Some developed cities can use natural gas to better protect the environment, while less developed Chinese cities still choose coal and gas as fuel. Due its rapid spread, air pollution is quickly transmitted to neighborhood cities. This transmission has resulted in increasingly worse air pollution in both cities and villages in China. In rural China, the rates of stomach and liver cancer are 50% higher than those in the country’s major cities . In part, this result may be due to the lack of water quality protection in rural areas. One of the goals published on November 8, 2018 by the Ministry of Ecology and the Environment and by the Ministry of Agriculture and Rural Affairs stated that by 2020, the utilization rate of fertilizers and pesticides in the country’s major crops will reach more than 40%, the coverage rate of soil testing and formula fertilization technology will reach more than 90%, the overall utilization rate of livestock and poultry fungi will exceed 75%, and the corresponding rate of equipment for sewage treatment plants in large farms will exceed 95% . These numbers further emphasize that water pollution in Chinese rural areas has become a major hazard . Moreover, garbage collection and treatment in rural areas has not been discussed until recent years . Furthermore, little attention has been paid to noise pollution in rural areas in China. Relative to urban areas, environmental protection infrastructures, pollution supervision and environmental protection technologies in rural areas have greatly lagged behind. In addition, due to the pressure of strict environmental policies in cities, some heavily polluting enterprises have been transferred to the villages to weaken the risk of punishment from environmental protection departments and to reduce their penalty costs . However, rural residents still lack awareness of the health risks of environmental pollution, partly due to inadequate policies aimed at controlling environmental pollution in rural areas. Disparate environmental health priorities in urban versus rural communities are also evident in the US , Canada , Japan , and Brazil . There are two main reasons for those outcomes based on current research. First, differential healthcare access is highly related to disparities in health outcomes. Second, due to differences in their physical environments, rural residents may experience more exposure due to agricultural, forestry, or mining practices, while urban residents may experience more exposure due to traffic-related emissions, power generation, and industrial process . The social environment is seldom considered an important factor influencing urban-rural differences in health outcomes, especially in Chinese research. In addition, health inequalities caused by environmental pollution may be broadened in the long term and are rarely discussed.
The reported rate of good health among rural residents (68.08%) was slightly higher than that reported by their urban counterparts (66.64%). In addition, the reported rate of poor health among rural residents (8.69%) was higher than that among urban residents (7.14%).
In this study, males were more likely to have a positive attitude towards their health status than females. These results are consistent with a study based on the first wave of the European Social Survey in 2003, which was conducted in 22 countries; in all countries, men report better health than women . The study based on the CGSS in 2010 also presented similar results among both urban and rural residents in China . Some studies have also found that women suffer from more nonfatal chronic conditions and a greater likelihood of functional limitations than men , although they live longer than men .
Residents aged 30 years or older were more likely to have a positive attitude towards their health status than were younger respondents, which applied to both urban and rural residents. Although health status declined with an advanced age  and young people were reported being more energetic and exercising more [32, 33], a greater socioeconomic status (SES) will highly promote residents to take advantage of new mechanisms that protect and promote better health and reduce their mortality risks . Young residents aged 29 years or younger are more likely to have lower SES levels compared with older residents.
Residents whose education level was primary school or below were more likely to have a negative attitude towards health than were those with a higher education level among both urban and rural residents, which is similar to the results of local studies showing that years of schooling have a positive impact on residents’ self-rated health [29, 35]. Education level is an indicator of SES and is correlated with income and occupation, as well as working and living conditions . Residents with low education levels are more likely to be influenced by disease and to have no access to medical interventions. A Western study also found that a higher level of education is positively associated with longer life and better health throughout the lifespan .
Most studies have shown that married adults enjoy better physical and mental health than unmarried adults  and have longer life expectancies than  divorced adults. In this study, compared with widowed residents, never married residents were more likely to be in good or poor health when comparing general health outcomes. In a universal marriage system, the tradition of marriage coexists with the modern culture of being single in China. Young residents enjoying their single status may have good health; however, others who did not get married at a marriageable age may have poor health when compared with individuals who were ever married, even if they lost their spouse. These widowed individuals are viewed as more successful in society based on the marriage tradition. Additionally, married or ever married residents were more likely to have a positive attitude towards their health than were others .
In this study, the father’s education level had a positive impact on urban and rural residents’ good health. The father’s education level is an important factor with regard to the family’s SES. A higher paternal education level means that the family’s income and occupation may be better, which creates better nutrition during the residents’ childhood and more medical resources when they face certain health risks.
The study has several implications. First, more advocates for environmental pollution should be provided, especially for rural residents, and these advocates should make the residents take notice of the seriousness of the air, water, garbage and noise pollution. This advocacy would help residents build an awareness of environmental protection in their daily life. Second, more official reports on the impact of environmental pollution on health in China should be published. The State of the Environment Report annually published by the Ministry of Ecology and Environment of China plays an important role in acknowledging the developments made by the Chinese government in enhancing the environment. However, little attention has been paid to rural residents and their environmental awareness. Third, measures to increase the protection of rural environments should be taken. For instance, some highly polluting enterprises should not be allowed to produce in villages. These enterprises continue to transfer pollution to rural areas, which adds risks and vulnerability to rural environments. This result may create risks for agricultural production and cause the peasants to lose their livelihood. More research is needed to determine the factors that influence rural residents’ health and their environmental awareness, as environmental right inequalities may create more health inequalities between urban and rural residents.
First, as a cross-sectional study, this study solely exhibits a static picture that cannot thoroughly describe the changes between the actual impacts of perceived environmental pollution on residents’ health. The questionnaire did not cover the participants’ demand to know about environmental pollution and health risks, which was relevant to the policy implications of the study. Second, the study captured some demographic and environmental factors in residents’ health but could not take all the individual differences into consideration, such as nutrition and physical exercise. Third, the results of this study were based on measurements of self-rated health. This approach may not reflect the real status of the residents’ physical health. In following studies, some objective assessments need to be added, such as those pertaining to chronic diseases. Finally, the large differences in the awareness of environmental pollution’s impacts on health between urban and rural residents are partly due to the priority of environmental protection policies in cities. This study did not involve the impacts of environmental policies.